Ankle arthrodesis

Original Editor ­ Michael Kauffmann

Top Contributors - Michael Kauffmann, Naomi O'Reilly, Rachael Lowe, Oyemi Sillo and George Prudden

Definition/Description

Ankle arthrodesis, also commonly referred to as joint fusion, is a surgical procedure which fuses the bones that form the ankle joint, essentially eliminating the joint. Ankle arthrodesis has remained the gold standard treatment for symptomatic primary, secondary and posttraumatic ankle arthritis[1][2]

Indication for Procedure

Patients with longstanding symptomatic ankle arthrosis who have joints so severely damaged that usual pain management techniques fail are candidates for arthrodesis. Once conservative measures have failed, surgery should be considered. [2][3][4]

Following indications could make patients suitable to an ankle arthrodesis[2][4] :

  • Posttraumatic and primary Arthrosis
  • Neuromuscular deformity
  • Revision of Failed Ankle Arthrodesis
  • Failed Total Ankle Replacement
  • Avascular Necrosis of theTalus (requiring tibiocalcaneal arthrodesis)
  • Neuroarthropathy (Charcot)
  • Rheumatoid Arthritis with severe deformity
  • Osteoarthritis
  • Pseudarthrosis

Ankle Arthrodesis should not be used if following conditions are present[2][4]:

  • Severe vascular deficiency
  • Osteomyelitis or soft tissue infection
  • Acute purulent infection
  • Total avascular necrosis of the talus
  • Severe peripheral arterial occlusive disease

Physical Therapy Management

As already mentioned at the indication for procedure only when conservative measures have failed, surgery should be considered. These conservative treatments include medication, bracing, orthotic management, shoe modifications, and intra-articular application of steroids.[2][3][5].

Relevant information the post-operative procession [3][6]:

  • Immediately after the surgery, the patient will receive a wide cast covererd by a gauze dressing. Occasionally the cast needs to be decompressed, since post-operative swelling of the ankle may occure.
  • Patient will be prescribed three days of bed rest.
  • The initial cast is changed to a second cast at two weeks postoperative.
  • After 2 months the initial cast is replaced by a weightbearing one and x-rays are taken. This implicates that weightbearing is not allowed for at least two months after operation. Only about 11 week after the operation full ankle loading is approached.
  • Over a period of approximately 3 months patient will use crutches, in order to ease the ankle in its weightbearing.
  • At three to four months, conversion is made to a removable walker boot and pins/screws are removed.
  • It will take about four months in order to make transition to a shoe.

Based on a guideline provided by the Balance Orthopaedic Foot and Ankle Center of Long Beach, physical therapy approach after ankle arhtrodesis will emphasize maximizing residual motion, strengthening the lower extremity, and in the later phases of physical therapy, emphasis will be placed on developing maximum smoothness of walking (gait). The guideline suggest to start with isometric excercises as soon as possible, on the day of the surgery.

Recent Related Research (from Pubmed)


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References

  1. Charles L. Saltzman, et al. Prospective Controlled Trial of STAR Total Ankle Replacement Versus Ankle Fusion: Initial Results. [Internet]. Foot & Ankle International/Vol. 30, No. 7/July 2009. Available from : http://www.orthofootankle.com/wp-content/uploads/2009/08/OAFC_award_winning_abstract.pdffckLRLevel of conclusion : 1B
Level of evidence : B
  2. 2.0 2.1 2.2 2.3 2.4 N. Espinosa, et al. Treatment of ankle osteoarthritis: arthrodesis versus total
ankle replacement. [Internet]. European Journal of Trauma and Emergency Surgery. 2010 November 13. Available from: http://www.springerlink.com.ezproxy.vub.ac.be:2048/content/344086n229118604/fulltext.pdffckLRLevel of conclusion : 1B
Level of evidence: B
  3. 3.0 3.1 3.2 Ricker Polsdorfer, et al. Arthrodesis of Foot and Ankle-Open Surgery. [Internet] The Doctors of USC 2011. Available from: http://www.doctorsofusc.com/condition/document/100911fckLRLevel of conclusion : 3B
Level of evidence: D
  4. 4.0 4.1 4.2 Joseph D, et al. Ankle Arthrodesis Nailing System. [Internet]. Stryker Trauma GmbH 2009. Available from:
http://www.osteosynthesis.stryker.com/medias/pdf/t2anklearthrodesis_optech_b1000044c3009.pdffckLRLevel of conclusion : 3B
Level of evidence: D
  5. Tallia AF, et al. Diagnostic and therapeutic injection of the ankle and foot. [Internet]. Am Fam Physician, 68(7):1356–62 ; 2003 Oktober. Available from : http://www.aafp.org/afp/2003/1001/p1356.htmlfckLRLevel of conclusion : 2B
Level of evidence: C
  6. Ronald W. Smith, et al. SUBTALAR ARTHRODESIS POST-OPERATIVE GUIDELINES. [Internet]. Balance Orthopaedic Foot and Ankle Center, Long Beach. Available from : http://www.balanceorthofoot.com/Forms/SUBTALAR%20ARTHRODESIS%20POSTOP%20GUIDES.pdffckLRLevel of conclusion : 5
Level of evidence : D